Влияние депрессии на отношение к болезни у пациентов с рассеянным склерозом

Abstract

Study Objective: To study the types of attitude to their disease in multiple sclerosis (MS) patients and the effects of depressive disorders on the internal picture of the disease. Study Design: This was a comparative prospective study. Materials and Methods: One hundred and twenty-nine patients with clinically verified MS, aged 15 to 61, participated in the study. They were divided into two groups: those who had MS without depression (n = 56) and those who had both MS and depression (n = 73). The study tools included the А. Beck Depression Inventory; a depression self-assessment scale developed at the V.M. Bekhterev Research Institute; the Khanin modification of the Spielberger State-Trait Anxiety Inventory, intended to assess personality-related and reactive anxiety; the Asthenia Assessment Scale developed by L.D. Malkova; and the “Mini-Mult” and “Attitude to Disease” personality assessment tools. Study Results: The study revealed that more than half of the MS patients had depression. The severity of their depressive disorders was consistent with a moderate depressive episode. Personality assessment of the MS patients with depression showed that women had high scores on the scales for depression and hysteria and moderate scores on the scales for paranoia and schizoid tendencies and males had high scores on the scales for psychopathy, paranoia, and psychasthenia. In the group of MS patients without depression, there were no statistically significant differences in scale scores between men and women. The MS patients without depression more often demonstrated ergopathic (р = 0.0006), anosognosic (p = 0.00003), or balanced (p = 0.01) attitudes to the disease, with a focus on maintaining their occupational status and continuing an active life, while the MS patients with depression exhibited attitudes related to particular personality traits, with signs of a disturbed social maladjustment and advantage by illness. Men with both MS and depression more often had neurasthenic and hypochondriacal attitudes and women with both MS and depression more frequently have sensitive, egocentric, paranoid or dysphoric attitudes to the disease, which are characterized by even more markedly disturbed social adjustment and various types of maladaptive behavior (using others to achieve their goals), and aggressive tendencies. Conclusion: Depressive disorders in MS patients significantly change their psychological structure and how they see the world around them, and reduce their resource capacities, making social adjustment more challenging and worsening their quality of life. When affective disorders are diagnosed in a timely manner and treated in their early stages, patients with MS choose more adaptive mechanisms of psychological defense and more adaptive attitudes to the disease, which improves their quality of life. Keywords: multiple sclerosis, type of attitude to a disease, depression, anxiety, social adjustment, internal picture of a disease.